Term
| Explain the anatomy of the Trachea |
|
Definition
|
|
Term
|
Definition
| - Contain progessively smaller amounts of cartilage and more smooth muscle. |
|
|
Term
|
Definition
| Contain NO cartilage, large amounts of smooth muscle. |
|
|
Term
|
Definition
- EXCHANGE surface,
closely associated with capillaries. |
|
|
Term
| What is the major function of the lungs? |
|
Definition
- Excrete C02
- Obtain O2. |
|
|
Term
| What happens at the alveoli? |
|
Definition
| - Diffusion between blood and air. |
|
|
Term
| ** Explain the steps in inspiration |
|
Definition
1) Diaphragm moves down, ribs move up and out.
2) Chest volume increases
3) Pressure inside the chest decreases.
4) Air moves into the chest due to the pressure gradient. |
|
|
Term
| ** Explain the steps in Expiration. |
|
Definition
1) The diaphragm moves up, and the ribs move down and in.
2) Chest volume decreases
3) Pressure inside the chest increases
4) air moves out of the chest due to the pressure gradient. |
|
|
Term
|
Definition
|
|
Term
T or F
- A person can have both Inspiratory and Expiratory problems. |
|
Definition
| False, only one or the other, not both. |
|
|
Term
|
Definition
| Difficulty breathing lying down. |
|
|
Term
|
Definition
| Difficulty breathing with exercise. |
|
|
Term
|
Definition
| - Inadequate alveolar ventilation in relation to metabolic demands (body needs). |
|
|
Term
|
Definition
| Alveolar ventilation that exceeds metabolism demands (body requirements). |
|
|
Term
|
Definition
| Levels of C02 in the blood. |
|
|
Term
| Hypoventilation --------> ? |
|
Definition
| HypERcapnia (Increased C02 in blood) |
|
|
Term
| Hyperventilation ----------> ? |
|
Definition
| HypOcapnia (Decreased levels of CO2 in the blood) |
|
|
Term
|
Definition
| - A protective reflex that cleanses the lower airway with an explosive expiration. |
|
|
Term
| What are some examples of a non-productive cough? |
|
Definition
- bronchitis
- VIRAL pneumonia
- aspiration
- tumor |
|
|
Term
| _____ is produced with a productive cough. |
|
Definition
|
|
Term
| What creates purulent sputum? |
|
Definition
|
|
Term
| What creates a Non-purulent sputum? |
|
Definition
| - A non-specific irritation. |
|
|
Term
| What are the different types of cough medicines? |
|
Definition
- Expectorants
- Suppresents |
|
|
Term
| You would use ______ to clear up a productive cough. |
|
Definition
|
|
Term
| You would use _______ to clear up a Non-productive cough. |
|
Definition
|
|
Term
What is Cyanosis?
What can help with Cyanosis? |
|
Definition
- Cyanosis is the bluish discoloration of the skin and mucous membrane due to increasing levels of unsaturated hemoglobin.
- Supplemental oxygen can help with cyanosis. |
|
|
Term
Explain Hemoptysis.
What does it indicate? |
|
Definition
- Coughing up blood or bloody secretions.
- Indicates a localized abnormality.
- D/DX
> Coughed up blood: bright red, alkaline
> Thrown up blood: dark red, acidic (from being in stomach acid) |
|
|
Term
What is pulmonary edema?
What are the mechanisms that cause it? |
|
Definition
- Increased fluid in the interstitial spaces of the lung.
- 3 Mechanisms that can cause it:
> L. sided CHF
> Inflammation
> Obstruction of a lymphatic duct |
|
|
Term
| How does L. sided CHF cause pulmonary edema? |
|
Definition
| Valvular dysfunction, Coronary Artery disease, L. Ventricular dysfunction -> Increase in L. atrial pressure -> Pulmonary Hypertension -> Pulmonary Edema |
|
|
Term
| How does inflammation cause pulmonary edema? |
|
Definition
| Injury to capillary endothelium ---> Increased permeability in the capillary and disruption of surfactant production by the alveoli --> leaking of fluid into interstitial spaces and alveoli ---> pulmonary edema |
|
|
Term
| How does blockage cause pulmonary edema? |
|
Definition
| - Lymphatic duct is blocked --> this prevents drainage from interstitial spaces ---> accumulation of fluids in interstitial spaces --> pulmonary edema |
|
|
Term
| What is pleaural effusion? |
|
Definition
| - The presence of fluid in the pleural space. |
|
|
Term
| What are the different types of fluid with pleural effusion? |
|
Definition
- Transudate
- Exudate
> empyema
> hemothorax
> chylothorax |
|
|
Term
| Explain Transudate Pleural Effusion |
|
Definition
- Hydrothorax (serious effusion)
- Edema fluid w/ very little protein and cell count
- may be grossly clear or yellowish
- Transudate "Transparent"
- Low specific gravity |
|
|
Term
| Explain Exudate Pleural Effusion |
|
Definition
- Fluid that is high in protein and or cell count
- Appears grossly cloudy
- High specific gravity |
|
|
Term
| Explain empyema in pleaural effusion |
|
Definition
- Numerous neutrophils are present
- pus |
|
|
Term
| Explain hemothorax pleural effusion |
|
Definition
- Serosanguinous effusion
- blood |
|
|
Term
| Explain Chylothorax pleural effusion |
|
Definition
| - Chyle (lymphatic fluid) |
|
|
Term
What is Atelectasis?
Results in? |
|
Definition
- Loss of lung volume due to inadequate expansion of airspaces.
- Results in inadequately oxygenated blood. |
|
|
Term
| What are the different types of atelectasis? |
|
Definition
- resorption atelectasis
- compression atelectasis
- microatelectasis
- contraction atelectasis
- Iatrogenic atelectasis |
|
|
Term
| Explain Resorbtion atelectasis |
|
Definition
- When an obstruction prevents air from reaching distal airways.
- Air already present gradually becomes present
- Some possible causes:
>tumor
>foreign body
> mucous plug |
|
|
Term
| Explain Compression atelectasis |
|
Definition
- Occurs with accumulations of fluid, air, or abnormal masses in the pleural cavity
- Takes up space -> Increased pressure in the thorax
- Pleural effusion: fluid
- pneumothorax: air
- Abnormal masses: tumor, Enlarged LN, Diaphragmatic hernia |
|
|
Term
| What are some selected Pulmonary diseases? |
|
Definition
- Asthma
- COPD (chronic obstructive pulmonary diseases)
> Emphysema
> Chronic bronchitis
- Cystic Fibrosis
- ARDS (acute respiratory distress syndrome)
- Pneumonias and infections
- Lung Cancer |
|
|
Term
| What does obstructive lung diseases result from? |
|
Definition
- Results from an anatomic airway narrowing
or
- from loss of elastic recoil |
|
|
Term
| What are some examples of obstructive lung diseases? |
|
Definition
| - asthma, emphysema, chronic bronchitis, bronchiectasis, cystic fibrosis |
|
|
Term
| With obstructive lung diseases you have difficulty on _______. |
|
Definition
|
|
Term
| What are the 3 most common obstructive lung diseases that sometimes overlap? |
|
Definition
- Chronic Bronchitis
- Asthma
- Emphysema |
|
|
Term
| What characterizes restrictive lung diseases? |
|
Definition
| - Reduced compliance in the lungs so that more pressure is required to expand the lungs. |
|
|
Term
| What are some types of restrictive lung diseases? |
|
Definition
- Extrapulmonary disorders
- Interstitial lung diseases |
|
|
Term
| Explain Extrapulmonary disorders |
|
Definition
| Affect the ability of the chest wall to act as a bellows. |
|
|
Term
| With restrictive lung diseases there is difficulty on _________. |
|
Definition
|
|
Term
| What characterizes asthma? |
|
Definition
| - Asthma is characterized by EPSISODIC, reversible bronchospams resulting from exaggerated bronchoconstrictor response from various stimuli. |
|
|
Term
| With Asthma ___________ effort is increased. |
|
Definition
|
|
Term
| Asthma is a chronic ______ disorder of the airways. |
|
Definition
|
|
Term
| What kind of clinical symptoms will you see with people who have asthma? |
|
Definition
- Episodic dyspnea
- Coughing
- Wheezing
- Many different manifistations:
> cough-variant asthma
> asthma without a wheeze |
|
|
Term
| Where does the pathogenesis of asthma occur? |
|
Definition
| - All happens in the bronchioles (no cartilage, lots of muscle) |
|
|
Term
ASTHMA:
- Persistent inflammation of the bronchi, is probably the underlying cause of the _________________. |
|
Definition
|
|
Term
| What are the 3 components of asthma? |
|
Definition
- Edema/inflammation
- bronchoconstriction
- mucus secreation |
|
|
Term
| What are the possible inducers or triggers of asthma? |
|
Definition
- pulmonary infection
- physiological stress
- inhaled irritants
- cold air temperatures
- allergies
- exercise |
|
|
Term
| Explain the histopathology of asthma |
|
Definition
1) Mucus in the lumen
2) Inflammation of the basement membrane
3) Enlargement of mucous glands
4) Hyperplasia of smooth muscle |
|
|
Term
| Intervals between asthmatic episodes are usually free from respiratory difficulties, although subtle respiratory deficits can be detected with a ______ _______ ________. |
|
Definition
|
|
Term
| What are the different therapies for asthma? |
|
Definition
- bronchodilators
- anti-inflammatory drugs
- mast cell stabilizers (cromolyn drugs) |
|
|
Term
| What does COPD stand for? |
|
Definition
| Chronic Obstructive Pulmonary Diseases |
|
|
Term
| What does COPD show evidence of? |
|
Definition
| It shows evidence of persistent and irreversible air flow obstruction. |
|
|
Term
| What are two common conditions of COPD? |
|
Definition
- Emphysema
- Chronic bronchitis |
|
|
Term
What two conditions often co-exist and share the same pathologic mechanism?
What is that mechanism? |
|
Definition
- Emphysema and chronic bronchitis often co-exist.
** The mechanism they both share is CIGARETTE SMOKING. |
|
|
Term
| What charactizes emphysema? |
|
Definition
| - Characterized by the enlargement of distal airways followed by he destruction of their walls. |
|
|
Term
| What conditions often complicate emphysema? |
|
Definition
| Emphysema is often complicated by chronic bronchitis and/or asthma. |
|
|
Term
| Explain the pathogenesis of Emphysema |
|
Definition
1) SMOKERS have accumulations of neutrophils and macrophages in their alveoli.
2) smoking stimulates the release of ELASTASE from neutrophils.
3) smoking enhances ELASTASE activity in macrophages.
4) oxidants in cigarette smoke and oxygen free radicals DECREASE ANTIELASTASE activity. |
|
|
Term
| Explain Chronic Bronchitis of the obstructive category |
|
Definition
- EXPIRATORY dyspnea
- hypersecretion of MUCUS and a persistent productive COUGH for at least 3 consecutive months in 2 consecutive years
- INFLAMMATION of the BRONCHI characterized by mucous gland hyperplasia, smooth muscle hypertrophy, bronchial wall thickening, and inflammation
- Often COMPLICATED by emphysema and/or astha |
|
|
Term
| What are the different types of chronic bronchitis? |
|
Definition
- Simple Chronic Bronchitis
- Chronic Mucopurulent bronchitis
- Chronic Asthmatic bronchitis
- Chronic obstructive bronchitis |
|
|
Term
| Simple Chronic Bronchitis |
|
Definition
| - MUCOID sputum, with NO airflow obstruction. |
|
|
Term
| Chronic mucopurulent bronchitis |
|
Definition
| PUS in the sputum due to SECONDARY infections (usually bacterial). |
|
|
Term
| Chronic Asthmatic Bronchitis |
|
Definition
| - Hyper responsive airway and intermittent asthma. |
|
|
Term
| Chronic Obstructive Bronchitis |
|
Definition
| - Chronic OUTFLOW obstruction (presumably due to EMPHYSEMA) |
|
|
Term
|
Definition
- An inherited disorder of the exocrine glands.
- The CF gene codes for a protein that regulates Chloride ion transport across the cell membrane.
- The result is an ABNORMALLY THICK MUCUS that tends to block ducts. |
|
|
Term
| Restrictive lung diseases are ________ problems. |
|
Definition
|
|
Term
| What does ARDS stand for? |
|
Definition
| Acute Respiratory distress syndrome |
|
|
Term
|
Definition
| - Diffuse Alveolar Damage |
|
|
Term
|
Definition
- Decrease in arterial oxygen pressure
- Decrease in lung compliance
- Pulmonary edema with out being caused by left sided heart failure (non-cardiogenic). |
|
|
Term
| What causes the injury in ARDS? |
|
Definition
- Neutrophils and macophages are generally involved in mediating the injury.
- Massive inflammatory response by the lungs. |
|
|
Term
| What conditions are associated with the development of ARDS? (What conditions cause ARDS?) |
|
Definition
- Infection
> SEPSIS
> Diffuse pulmonary infections
> bacterial endotoxins
- Physical Injury
> MULTIPLE TRAUMA
> pulmonary contusions
> burns
> near drowning
- Inhaled Irritants
> smoke
> irritant gasses and toxic fumes
- Hematologic Conditions
> multiple transfusions
> DIC (Death is coming) (clotting everywhere in the body)
- Shock
- Many more |
|
|
Term
| Explain the pathogenesis of ARDS |
|
Definition
Begins as either:
- Damage to the endothelial cells of the capillary
> e.g. sepsis
- Damage to the endothelial cells of the alveoli
> e.g. viral or bacterial pneumonia
> e.g. Inhilation of toxic fumes
- Or both
> inhilation of hot air -> pulmonary burns -> destroys alveolar wall |
|
|
Term
| Explain the pathogenesis of inflammation in ARDS |
|
Definition
- Inflammatory mediators are released.
- Increased permeability in the alveolar blood vessels.
- loss of cells lining the alveoli
- Accumulation of FLUID in the alveolar spaces
- Hemorrhage and CLOT formation in the alveoli
- Formation of a HYALINE membrane in alveoli
- Acute respiratory failure
- Decreased production of surfactant -> atelectasis |
|
|
Term
| Explain the clinical features of ARDS |
|
Definition
- Symptoms of SEVERE DISTRESS and DYSPNEA occur within 24 hours of the inciting event.
- X-rays: shows DIFFUSE CONSOLIDATION in the lungs
- Most patients need VENTILATOR THERAPY
- VERY HIGH MORTALITY:
> 1/3 die within days
> 1/3 die from pneumonia and Right sided heart failure within weeks
> 1/3 live, but with chronic respiratory problems related to fibrosis -> Contraction Atelectasis |
|
|
Term
| The lungs are at risk for infection when.... |
|
Definition
- Constantly exposed to contaminated air
- NASOPHARYNGEAL FLORA ARE REGULARLY ASPIRATED
- Other lung diseases make the lungs more vulnerable to infection |
|
|
Term
| List the pulmonary defenses: |
|
Definition
- Filtering done by noise hairs
- Mucus blanket moved by ciliated epithelium
- IgA secreted by upper respiratory tract
- resident alveolar macrophages
- regional lymph nodes can create an immune response |
|
|
Term
| What are the risk factors for pulmonary infection? |
|
Definition
- Inhibition of the mucociliary system
- Cells in the bronchial epithelium dying |
|
|
Term
| What are possible causes of inhibition of the mucociliary system? |
|
Definition
- Smoking
- Chronic bronchitis
- general anesthesia
- endotrachreal intubation
- immobility
- METAPLASIA |
|
|
Term
| What can cause the cells in the bronchial epithelium to be destroyed? |
|
Definition
- Enzymes or toxins released by organisms
- Inhalation of smoke or toxic gas
- Aspiration of gastric contents
- physical trauma
- some chronic diseases |
|
|
Term
|
Definition
| An inflammation of the alveoli, interstitial tissue, and/or bronchioles due to infection by bacteria, viruses, or other pathogenic organisms, OR to irritation by chemicals or other agents. |
|
|
Term
| Pneumonia occurs in ________ people in the _____ each year. |
|
Definition
|
|
Term
| Pneumonia is the _____ leading cause of death. |
|
Definition
|
|
Term
| Pneumonia is the most common cause of _____ due to ____. |
|
Definition
|
|
Term
| What are the different classifications of pneumonias? |
|
Definition
- Etiological classification
Infectious vs. Non Infectious
- Infectious subclassifications:
Primary vs. secondary
Bacterial, Viral, Mycotic (funal)
Nosocomial (from a hospital)
- Radiological classifications:
alveolar pneumonia
interstitial pneumonia |
|
|
Term
| Explain Alveolar Pneumonia |
|
Definition
- Infection results in the accumulation of exudates in the lumen of the alveoli
- May lead to CONSOLIDATION
- Usually BACTERIAL ORIGIN |
|
|
Term
| Explain Interstitial Pneumonia |
|
Definition
- Inflammation affects the alveolar SEPTA
- often diffuse & BILATERAL
- Usually VIRAL origin |
|
|
Term
| What are the types of alveolar pneumonia's? |
|
Definition
- bronchopneumonia
- lobar pneumonia |
|
|
Term
|
Definition
| - Patchy distribution of inflammation that generally involves more than one lobe. |
|
|
Term
|
Definition
- Airspaces of part or all of a lobe are homogenously filled with an exudate.
- -> CONSOLIDATION |
|
|
Term
| Explain Aspiration Pneumonia |
|
Definition
- Caused by the inhalation of food particles, gastric contents, or other substances
- partly chemical, partly bacterial |
|
|
Term
| Explain Atypical Pneumonia |
|
Definition
- Caused by mycoplasma pneumonia
- An intracellular ogranism that causes necrosis of the alveolar septal cells |
|
|
Term
| Explain Hypostatic Pneumonia |
|
Definition
- Bacterial infection superimposed on pulmonary edema
- Most common in elderly, debilitated people who are confined to a bed. |
|
|
Term
| What are the bacterial types of pneumonia? |
|
Definition
- Legionnaire's disease
- Pneumococcal Pneumonia |
|
|
Term
| Explain Legionnaire's disease |
|
Definition
- Resides in the cytoplasm of alveolar macrophages
- Can cause massive consolidation and necrosis |
|
|
Term
| Explain Pneumococcal Pneumonia |
|
Definition
- Vaccine available
- Causes inflammation which leads to alveolar edema
- The edema creates a medium for bacteria to multiply and spread and leads to consolidation
- when the bacteria lysis, it releases TOXINS. |
|
|
Term
| What is the official name of croup? |
|
Definition
| Acute Laryngotracheobronchitis |
|
|
Term
| Explain Croup (Acute Laryngotracheobronchitis) |
|
Definition
- Children between 6 months -> 5 yrs of age
- Etiology: 85% viral
- WINTER > SSF
- subglottic area becomes obstructed
- barking, seal-like cough
- most cases resolve in 24-48 hours
- Severe cases can lead to hospitalization |
|
|
Term
|
Definition
- Etiology: Myobacterium tuberculosis
- Rate of infection for foreign born americans is 7x more likely than american born citizens.
- Spread of the organism is through AIRBORN transmission
- Inflammation occurs and causes some of the organism to be walled off into tubercles or granulomas that contain dormant organisms.
- Impaired immunity allows organism to spread throughout the body. |
|
|
Term
| Give details on: Squamous Cell Carcinoma |
|
Definition
- Mostly found in guys
- Close correlation to smoking
- Easier to detect early on
- Doesn't spread until later in comparison to other types |
|
|
Term
| Give details on: Adenocarcinoma |
|
Definition
- More associated with women AND nonsmokers
- weak association with smoking
- tends to be more peripheral
- sometimes associated with SCARRING |
|
|
Term
| Give details on: Small Cell Carcinoma |
|
Definition
- STRONGEST correlation with smoking
- Spreads often, high chance of metastasis, 70% of people who are diagnosed have already metastasized
- rarely resectable (removable via surgery)
- w/o treatment, 1/2 the people die within 12-15 weeks
- Paranoplastic syndromes often exist (random syndrome associated with in) |
|
|
Term
| Give details on: Large cell carcinoma |
|
Definition
- HIGHLY ANAPLASTIC, metastasize early on
- Worst prognosis of all 4 types |
|
|
